1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1st or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
My research interests are prevention and treatment of lung cancer. Cigarette smoking as a prevention of lung cancer and the heath disparities is illustrated in the Thomas et al. paper. SES clearly plays a pivotal role in prevalence of smoking as evident in 2016 statistics – Education (College Grad+ 7%, < High School 24%), Poverty (>400% FPL 10%, < 100% FPL 30%), Race/Ethnicity (Native Americans 25%, Asians 12%). This has translated into increase incidence in minorities with 20% higher incidence in blacks. Trials in lung cancer treatment have trends which are even worse when it comes to enrolling minorities. Consequently, the treatment outcomes are extrapolated from the results of the majority white participants enrolled. The first- and second-generation framework is established. I would like to focus on third- and fourth-generation work by utilizing some of the principles of Public Health Critical Race praxis such as Race consciousness by engaging the research staff to reach out to minorities for increased participation, Voice by establishing a community research advisory board where minority participants can share their perspectives. Finally, self-reflection to be able to address the complex racialized issues.
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Walton article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level. (Note: Next week we will discuss policy-level interventions designed to directly impact social determinants).
Current standard of care for lung cancer screening is to perform Low-dose Computed Tomography (LDCT) for high risk individuals – age 55-74 years and >= 30 pack-years of smoking who currently smoke or quit smoking less than 15 years ago. Such screening is aimed to detect lung cancers at an early stage so that these individuals can undergo curative surgical resection. As we have seen, the Native Americans, Blacks and Hispanics have a higher rate of smoking and are consequently at higher risk. However, they have a low rate of participation. One can try to improve their participation by safety-net level approach similar to barbershop intervention. Places where the members of the community come to participate are good places to improve public awareness – community centers, community health centers, places of worship. Organizing awareness events and workshops will likely improve community participation in lung cancer screening programs and decrease health disparities in this important health issue.